My student: ADHD or Bipolar?

Q: Dr. Phelps, I am a teacher and I had a student who was diagnosed with ADHD, so they put him on Ritalin. The more I watched him and got to know him I found out that he did not seem to be ADHD. He was suicidal, anti-social, he had mood swings, self-destructive, he had periods of memory loss(not knowing who he was or who I was), he went on little sleep, used poor judgement, hid a butcher knife in his bedroom (luckily his brother saw it), etc. He exhibited the symptoms of a bipolar child. His mother said she asked the doctor about a bipolar disorder and he would not listen to her concerns. We live in a very deprived area where children are prescribed Ritalin without very much consultation. Does he sound bipolar? What steps should the parents take?

Dear Teacher --
Though I am not a child psychiatrist, so am not following that literature closely, it is my impression that at least among mood specialists who work with kids, the thinking is that ADHD and Bipolar are extremely difficult to distinguish at a young age.  Researchers and clinicians worry aloud about whether stimulants like Ritalin can make bipolar disorder worse, and how to screen for bipolar disorder to minimize that risk if it exists.

I will confess that my colleagues think everything "sounds bipolar" to me, so perhaps that should not be the yardstick we use here (smile).  Obviously you have learned enough to be very concerned yourself.  You may have seen the excellent website about bipolar children, written mostly for their parents but probably very useful in your circumstance:

Then what do you do?  Send a copy of this reply to their parents? Or even to the prescribing doctor? (!? -- this would be considered intrusive by current practice standards, and when you think about it, who am I to be so bold as to think I know enough to even speak about what to do for young boy I've never even seen.  So I wouldn't presume to say what to do, only second your concerns as legitimate ones).  Perhaps the resources you will find at BPKIDS will give you an article or two you might pass along to the prescribing doctor, via the parents, about your concern?  Good luck.  Don't presume you're right about bipolar disorder, because that kind of certainty tightens everybody up -- just keep asking open questions, that seems to have worked best for me...

Dr. Phelp

Published January, 2001